Healthcare Provider Details

I. General information

NPI: 1629799150
Provider Name (Legal Business Name): DEANNA DEBARTOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 OAKDALE AVE STE 305
CHATSWORTH CA
91311-6539
US

IV. Provider business mailing address

618 DOUBLE EAGLE DR
SIMI VALLEY CA
93065-6677
US

V. Phone/Fax

Practice location:
  • Phone: 661-274-8454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: